A patient has pain, swelling, and tenderness at the medial border of the hand, with changes in skin color and temperature, hyperhidrosis, and progressive joint stiffness in the wrist and hand. The MOST likely cause is:

A patient has pain, swelling, and tenderness at the medial border of the hand, with changes in skin color and temperature, hyperhidrosis, and progressive joint stiffness in the wrist and hand. The MOST likely cause is:

• A. reflex sympathetic dystrophy
• B. cervical disc disease
• C. raynaud's phenomenon
• D. carpal tunnel syndrome

Answer: (A)

The pattern points to reflex sympathetic dystrophy, now called complex regional pain syndrome (CRPS). It involves autonomic dysfunction after a hand insult, leading to ongoing pain with noticeable changes in skin color and temperature, swelling, increased sweating (hyperhidrosis), and progressive stiffness in the joints. These signs reflect abnormal sympathetic nervous system activity affecting the affected hand. Why this fits best: the combination of persistent pain with edema, color and temperature changes, and sweating is characteristic of CRPS in the hand. Other conditions don’t produce this same mix: cervical disc disease would mainly cause neck-related radicular pain with numbness or weakness, not swelling and skin color/temperature changes; Raynaud’s phenomenon involves episodic vasospasm with color changes (often triggered by cold) but not the persistent edema and hyperhidrosis seen here; carpal tunnel syndrome causes numbness, tingling, and weakness in the median nerve distribution without autonomic signs like color/temperature shifts or sweating.

The pattern points to reflex sympathetic dystrophy, now called complex regional pain syndrome (CRPS). It involves autonomic dysfunction after a hand insult, leading to ongoing pain with noticeable changes in skin color and temperature, swelling, increased sweating (hyperhidrosis), and progressive stiffness in the joints. These signs reflect abnormal sympathetic nervous system activity affecting the affected hand.

Why this fits best: the combination of persistent pain with edema, color and temperature changes, and sweating is characteristic of CRPS in the hand. Other conditions don’t produce this same mix: cervical disc disease would mainly cause neck-related radicular pain with numbness or weakness, not swelling and skin color/temperature changes; Raynaud’s phenomenon involves episodic vasospasm with color changes (often triggered by cold) but not the persistent edema and hyperhidrosis seen here; carpal tunnel syndrome causes numbness, tingling, and weakness in the median nerve distribution without autonomic signs like color/temperature shifts or sweating.